Every Family doctor probably have seen a patient brought to his clinic with blood dripping from one side of his nose.
Any bleeding should be seen as soon as possible and treated.
A Nosebleed is said to have occurred when the nose begins to bleed from the inner mucosa or lining of the nose.
There is a layer of moist, delicate skin with a rich supply of blood vessels covering the interior of the nose.
Once you break the skin of this part of the nose for example by nose picking the blood vessel will burst resulting in bleeding or sneezing very hard .
Anterior nosebleeds involving the lower front portion of the nasal septum are very common and are not serious
All that is required to stem it are some local pressure and a little patience.
A nosebleed may also be caused by irritation or dryness of the lining of the nose, which may occur in a dry environment, allergic rhinitis, colds, or sinusitis.
Deviated septum, foreign objects in the nose, or injury to the nose like boxing may also cause nosebleeds.
Very rarely a nosebleed is life threatening or fatal.
The bleeding is usually from a posterior nosebleed, in which the site of bleeding is higher and deeper within the nose and the blood flows primarily down the back of the throat.
The more dangerous causes could be:
cancer of the nose
hypertension,
fever and infections
bleeding disorder,
the use of anticoagulant medication
One of my patient was given warfarin ( a very potent anticoagulant by her heart specialist) for thinning the blood to prevent clots going to her brain or her heart. Although the blood results showed the blood was dangerously thin, her warfarin dosage was not reduced.
She complained of giddiness and while feeding some cats fell down and knocked her head on the ground.
I was called to attend to her. She was bleeding from the nose . The danger was the blood clotting and choking her through the airway. I immediately turned her to the side so that the blood came out through the mouth and not into her airway.
I asked a passerby to call for an ambulance and quickly use a suction pump to suck out blood from her mouth and nose.
Her airway was cleared of blood and her breathing was satisfactory even though she was unconscious.
When the ambulance came and took her to the hospital, she managed to wake up while on the way to hospital.
She was found to have a subarachnoidal hemorrhage due to her injury and the warfarin which also cause her to bleed from the brain and nose.
The common risk factors of nose bleeding include:
A hot, dry indoor climate - The hot, dry indoor air causes the delicate nasal skin to crack and bleed.
Colds and allergies - causes nasal blood vessel inflammation which can bleeding.
Exposure to irritating chemicals - Cigarette smoke, ammonia, gasoline or other chemical irritants.
A deviated septum produces an uneven airflow pattern causes the skin on the nasal septum to become dry and cracked, increasing the risk of bleeding.
Nosebleeds are also commonly caused by trauma such as nose picking, forceful blowing of the nose or severe facial trauma or contact sports.
Medications that delays blood clotting eg anticoagulants and non steroidal anti-inflammatory drugs eg aspirin and ibuprofen.
Medical conditions include chronic renal disease (kidney failure), thrombocytopenia (low levels of the blood platelets) and hereditary bleeding disorders, such as hemophilia.
Once I determine that it is a anterior nosebleed, I would make the patient:
1.Sit up, lean forward and breathe through his/her mouth.
2.Pinch the entire front of the nose, just above the nostrils, and hold it for five minutes.
3.Apply an ice pack or a plastic bag of crushed ice to the nose to slow the blood flow.
4.After I have pinched the nose for five minutes, release it to see if the nosebleed continues.
5.If the nose is still bleeding, pinch it for an additional 10 minutes.
6.After 10 minutes, release the pressure on the nose again.
7.After the blood flow has stopped, ask the patient not to breathe through the nose.
8.If the nose is still bleeding, the family doctor may treat the problem by:
a.Packing your nose with gauze
b.Cauterizing (sealing off) the injured blood vessel with a chemical, such as silver nitrate, or with an electric probe
c.Applying medication like silvadene cream directly to the inside of the nose to stop the bleeding
If bleeding do not stop, the patient may need to be treated in the hospital to exclude posterior bleeding causes.
Prevention of nose bleeding measure are:
1.Not picking the nose
2. Being gentle when blowing the nose
3. Not smoking
4.Using a saline nasal spray or petroleum jelly to moisturize the inside of the nose
5. Avoiding facial trauma by using well-fitting headgear to protect your face during contact sports
6.Using protective equipment to avoid breathing chemicals at work
Most nosebleeds are usually harmless and are almost always easy to stop. However any nose bleed may be an indication of something serious.
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